Provider Demographics
NPI:1962755173
Name:BROWN, CAROL ANNE (LGSW)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 JESSAMINE ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:36555-6004
Mailing Address - Country:US
Mailing Address - Phone:931-625-6081
Mailing Address - Fax:
Practice Address - Street 1:12100 JESSAMINE ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:36555-6004
Practice Address - Country:US
Practice Address - Phone:931-625-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLG150251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health